MRCS PART A · PAPER 2 · PRINCIPLES OF SURGERY
Paper 2 pilot: choose the blood-product indication
Four selected five-option questions: one foundation application and three applied decisions. Fictional adult cases outside major haemorrhage; not a full mock or calibrated assessment. Platform owner reviewed and authorised release. Source checks used indexed NICE NG24 text; direct full-page access was unavailable.
3 topics · 4 original SBAs
1 · Procedure and site change the platelet target
Your task: Distinguish critical-site surgery from the general invasive-procedure threshold.
Which feature changes the target in the first case?
The operation is within the central nervous system. NICE NG24 1.3.6 describes considering prophylactic platelets to raise the count above 100×10⁹/L for critical-site surgery; its general procedure recommendation uses above 50×10⁹/L. This is a consideration within specialist planning, not automatic permission to operate.
Does every procedure need the same prophylaxis?
No. Site, bleeding risk, count trend, the cause of thrombocytopenia and other haemostatic abnormalities matter. NICE also identifies low-risk procedures where prophylactic platelets are not offered. An isolated laboratory count is not the whole plan.
2 · Abnormal coagulation is not an isolated indication
Your task: Compare non-bleeding laboratory abnormalities with clinically significant bleeding and abnormal coagulation.
What must be established before treating a coagulation result with plasma?
Ask whether there is clinically significant bleeding, an upcoming procedure with relevant bleeding risk, major haemorrhage or anticoagulant reversal. NICE NG24 1.4.2 does not support FFP solely to correct abnormal coagulation in a non-bleeding patient without a relevant procedure. Investigate the cause instead of normalising a number reflexively.
What changes in a bleeding patient outside major haemorrhage?
With clinically significant bleeding and abnormal coagulation, NICE 1.4.1 supports considering FFP—for example with PT or aPTT ratios above 1.5. Reassess the clinical response and coagulation afterwards. This does not replace surgical bleeding-source assessment.
3 · Match fibrinogen replacement to the bleeding context
Your task: Distinguish a bleeding fibrinogen indication from prophylaxis or major-haemorrhage protocols.
Why does 1.2 g/L matter in the fourth case?
There is clinically significant bleeding without major haemorrhage. NICE NG24 1.5.1 supports considering cryoprecipitate when fibrinogen is below 1.5 g/L in that context. Component treatment runs alongside source control and repeat assessment, not instead of them.
Would the same result always imply transfusion without bleeding?
No. NICE 1.5.2 does not support correction in a non-bleeding patient without a relevant invasive procedure. The prophylactic procedure recommendation 1.5.3 uses below 1.0 g/L. Major haemorrhage needs its own urgent protocol and team.